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Journal of Pediatric Nursing 2022Medication errors are a great concern to health care organisations as they are costly and pose a significant risk to patients. Children are three times more likely to be... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Medication errors are a great concern to health care organisations as they are costly and pose a significant risk to patients. Children are three times more likely to be affected by medication errors than adults with medication administration error rates reported to be over 70%.
OBJECTIVE
To identify nursing interventions to reduce medication administration errors and perform a meta-analysis.
METHODS
Online databases; British Nursing Index (BNI), Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE and MEDLINE were searched for relevant studies published between January 2000 to 2020. Studies with clear primary or secondary aims focusing on interventions to reduce medication administration errors in paediatrics, children and or neonates were included in the review.
RESULTS
442 studies were screened and18 studies met the inclusion criteria. Seven interventions were identified from included studies; education programmes, medication information services, clinical pharmacist involvement, double checking, barriers to reduce interruptions during drug calculation and preparation, implementation of smart pumps and improvement strategies. Educational interventional aspects were the most common identified in 13 out of 18 included studies. Meta-analysis demonstrated an associated 64% reduction in medicine administration errors post intervention (pooled OR 0.36 (95% Confidence Interval (CI) 0.21-0.63) P = 0.0003).
CONCLUSION
Medication safety education is an important element of interventions to reduce administration errors. Medication errors are multifaceted that require a bundle interventional approach to address the complexities and dynamics relevant to the local context. It is imperative that causes of errors need to be identified prior to implementation of appropriate interventions.
Topics: Adult; Child; Drug Dosage Calculations; Humans; Infant, Newborn; Medication Errors; Pediatrics; Pharmaceutical Preparations; Pharmacists
PubMed: 34507851
DOI: 10.1016/j.pedn.2021.08.024 -
BMC Health Services Research Oct 2021The aim of the third WHO challenge released in 2017 was to attain a global commitment to lessen the severity and to prevent medication-related harm by 50% within the... (Review)
Review
BACKGROUND
The aim of the third WHO challenge released in 2017 was to attain a global commitment to lessen the severity and to prevent medication-related harm by 50% within the next five years. To achieve this goal, comprehensive identification of barriers to reporting medication errors is imperative.
OBJECTIVE
This review systematically identified and examined the barriers hindering nurses from reporting medication administration errors in the hospital setting.
DESIGN
An integrative review.
REVIEW METHODS
PubMed, Web of Science, EMBASE, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) including Google scholar were searched to identify published studies on barriers to medication administration error reporting from January 2016 to December 2020. Two reviewers (AA, and KDK) independently assessed the quality of all the included studies using the Mixed Methods Appraisal Tool (MMAT) version 2018.
RESULTS
Of the 10, 929 articles retrieved, 14 studies were included in this study. The main themes and subthemes identified as barriers to reporting medication administration errors after the integration of results from qualitative and quantitative studies were: organisational barriers (inadequate reporting systems, management behaviour, and unclear definition of medication error), and professional and individual barriers (fear of management/colleagues/lawsuit, individual reasons, and inadequate knowledge of errors).
CONCLUSION
Providing an enabling environment void of punitive measures and blame culture is imperious for nurses to report medication administration errors. Policymakers, managers, and nurses should agree on a uniform definition of what constitutes medication error to enhance nurses' ability to report medication administration errors.
Topics: Fear; Hospitals; Humans; Medication Errors; Nurses; Patient Safety
PubMed: 34696788
DOI: 10.1186/s12913-021-07187-5 -
BMC Health Services Research Sep 2019Medication errors are a serious and complex problem in clinical practice, especially in intensive care units whose patients can suffer potentially very serious...
BACKGROUND
Medication errors are a serious and complex problem in clinical practice, especially in intensive care units whose patients can suffer potentially very serious consequences because of the critical nature of their diseases and the pharmacotherapy programs implemented in these patients. The origins of these errors discussed in the literature are wide-ranging, although far-reaching variables are of particular special interest to those involved in training nurses. The main objective of this research was to study if the level of knowledge that critical-care nurses have about the use and administration of medications is related to the most common medication errors.
METHODS
This was a mixed (multi-method) study with three phases that combined quantitative and qualitative techniques. In phase 1 patient medical records were reviewed; phase 2 consisted of an interview with a focus group; and an ad hoc questionnaire was carried out in phase 3.
RESULTS
The global medication error index was 1.93%. The main risk areas were errors in the interval of administration of antibiotics (8.15% error rate); high-risk medication dilution, concentration, and infusion-rate errors (2.94% error rate); and errors in the administration of medications via nasogastric tubes (11.16% error rate).
CONCLUSIONS
Nurses have a low level of knowledge of the drugs they use the most and with which a greater number of medication errors are committed in the ICU.
Topics: Critical Care Nursing; Critical Illness; Female; Focus Groups; Health Knowledge, Attitudes, Practice; Humans; Intensive Care Units; Intubation, Gastrointestinal; Male; Medication Errors; Middle Aged; Pharmaceutical Preparations; Surveys and Questionnaires
PubMed: 31492188
DOI: 10.1186/s12913-019-4481-7 -
British Journal of Clinical Pharmacology Feb 2021Look-alike or sound-alike (LASA) medication names may be mistaken for each other, e.g. mercaptamine and mercaptopurine. If an error of this sort is not intercepted, it... (Review)
Review
Look-alike or sound-alike (LASA) medication names may be mistaken for each other, e.g. mercaptamine and mercaptopurine. If an error of this sort is not intercepted, it can reach the patient and may result in harm. LASA errors occur because of shared linguistic properties between names (phonetic or orthographic), and potential for error is compounded by similar packaging, tablet appearance, tablet strength, route of administration or therapeutic indication. Estimates of prevalence range from 0.00003 to 0.0022% of all prescriptions, 7% of near misses, and between 6.2 and 14.7% of all medication error events. Solutions to LASA errors can target people or systems, and include reducing interruptions or distractions during medication administration, typographic tweaks, such as selective capitalization (Tall Man letters) or boldface, barcoding, and computerized physician order entry.
Topics: Humans; Male; Medical Order Entry Systems; Medication Errors; Pharmaceutical Preparations
PubMed: 32198938
DOI: 10.1111/bcp.14285 -
Nurse Education Today Jan 2020Medication errors are the most common clinical errors in healthcare practice and can lead to serious consequences. Medication error encouragement training (MEET) brings... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Medication errors are the most common clinical errors in healthcare practice and can lead to serious consequences. Medication error encouragement training (MEET) brings students face-to-face with potential errors in the medication process, in a safe environment where they are encouraged to understand both the error and the context in which it occurred.
OBJECTIVES
The study aimed to examine the effects of a MEET intervention on medication safety confidence among nursing undergraduates.
DESIGN
This was a quasi-experimental study with a nonequivalent control group design.
PARTICIPANTS
Our sample was recruited from the nursing education department of a university, with 47 participants randomly assigned to the experimental group, and 50 to the control group.
METHODS
Both groups received theoretical training, followed by applied training. The experimental group received the MEET intervention developed specifically for this study, while the control group received traditional error avoidance training. Participants' medication administration confidence was measured pre- and post-intervention.
RESULTS
Following training, the experimental group's confidence was significantly higher than that of the control group. With regard to individual medication administration procedures, the experimental groups' medication safety confidence increased significantly after training compared to the control group in patient identification, drug information confirmation, and drug preparation.
CONCLUSIONS
Introducing MEET into nursing curricula could reduce medication errors and related complications in healthcare institutions. Further studies are needed to investigate the long-term effects of MEET interventions, as well as the generalizability of our findings.
Topics: Clinical Competence; Curriculum; Education, Nursing, Baccalaureate; Female; Humans; Male; Medication Errors; Patient Safety; Students, Nursing; Young Adult
PubMed: 31698293
DOI: 10.1016/j.nedt.2019.104250 -
Economic analysis of the prevalence and clinical and economic burden of medication error in England.BMJ Quality & Safety Feb 2021To provide national estimates of the number and clinical and economic burden of medication errors in the National Health Service (NHS) in England.
OBJECTIVES
To provide national estimates of the number and clinical and economic burden of medication errors in the National Health Service (NHS) in England.
METHODS
We used UK-based prevalence of medication errors (in prescribing, dispensing, administration and monitoring) in primary care, secondary care and care home settings, and associated healthcare resource use, to estimate annual number and burden of errors to the NHS. Burden (healthcare resource use and deaths) was estimated from harm associated with avoidable adverse drug events (ADEs).
RESULTS
We estimated that 237 million medication errors occur at some point in the medication process in England annually, 38.4% occurring in primary care; 72% have little/no potential for harm and 66 million are potentially clinically significant. Prescribing in primary care accounts for 34% of all potentially clinically significant errors. Definitely avoidable ADEs are estimated to cost the NHS £98 462 582 per year, consuming 181 626 bed-days, and causing/contributing to 1708 deaths. This comprises primary care ADEs leading to hospital admission (£83.7 million; causing 627 deaths), and secondary care ADEs leading to longer hospital stay (£14.8 million; causing or contributing to 1081 deaths).
CONCLUSIONS
Ubiquitous medicines use in health care leads unsurprisingly to high numbers of medication errors, although most are not clinically important. There is significant uncertainty around estimates due to the assumption that avoidable ADEs correspond to medication errors, data quality, and lack of data around longer-term impacts of errors. Data linkage between errors and patient outcomes is essential to progress understanding in this area.
Topics: Cost of Illness; Drug-Related Side Effects and Adverse Reactions; England; Humans; Medication Errors; Prevalence; State Medicine
PubMed: 32527980
DOI: 10.1136/bmjqs-2019-010206 -
Work (Reading, Mass.) 2023Medication administration errors by nurses form a high proportion of medical errors in medical institutions. Studies have shown that such errors are closely linked to...
BACKGROUND
Medication administration errors by nurses form a high proportion of medical errors in medical institutions. Studies have shown that such errors are closely linked to nursing workload.
OBJECTIVE
To quantitatively explore the effects of different types of nursing workloads on different medication administration errors.
METHOD
Three medical institutions were selected as the objects of error data collection based on the following criteria: the medical institution experience in error data collection, the complete range of medical departments, and the institution size. Error cases were self-reported from all nurses in all medical departments. The relationship between the error types and nursing workload types were quantitatively examined using partial least squares and structural equation modeling.
RESULTS
The study recorded 290 medication administration errors, and extracted four error types and nine nursing workload types. The workload type for each error type was also identified and the path coefficient was found to be between 0.087 to 0.416.
CONCLUSION
This study confirmed the effect of workload on medication administration errors and determined a theoretical mechanism for this effect. Research results will provide the evidence for nursing managers to reduce workload and ensure quality in the nursing administration process.
Topics: Humans; Workload; Medication Errors; Medical Errors; Data Collection
PubMed: 36214028
DOI: 10.3233/WOR-211392 -
Drug Safety Dec 2019Children admitted to paediatric and neonatal intensive care units may be at high risk from medication errors and preventable adverse drug events.
INTRODUCTION
Children admitted to paediatric and neonatal intensive care units may be at high risk from medication errors and preventable adverse drug events.
OBJECTIVE
The objective of this systematic review was to review empirical studies examining the prevalence and nature of medication errors and preventable adverse drug events in paediatric and neonatal intensive care units.
DATA SOURCES
Seven electronic databases were searched between January 2000 and March 2019.
STUDY SELECTION
Quantitative studies that examined medication errors/preventable adverse drug events using direct observation, medication chart review, or a mixture of methods in children ≤ 18 years of age admitted to paediatric or neonatal intensive care units were included.
DATA EXTRACTION
Data on study design, detection method used, rates and types of medication errors/preventable adverse drug events, and medication classes involved were extracted.
RESULTS
Thirty-five unique studies were identified for inclusion. In paediatric intensive care units, the median rate of medication errors was 14.6 per 100 medication orders (interquartile range 5.7-48.8%, n = 3) and between 6.4 and 9.1 per 1000 patient-days (n = 2). In neonatal intensive care units, medication error rates ranged from 4 to 35.1 per 1000 patient-days (n = 2) and from 5.5 to 77.9 per 100 medication orders (n = 2). In both settings, prescribing and medication administration errors were found to be the most common medication errors, with dosing errors the most frequently reported error subtype. Preventable adverse drug event rates were reported in three paediatric intensive care unit studies as 2.3 per 100 patients (n = 1) and 21-29 per 1000 patient-days (n = 2). In neonatal intensive care units, preventable adverse drug event rates from three studies were 0.86 per 1000 doses (n = 1) and 0.47-14.38 per 1000 patient-days (n = 2). Anti-infective agents were commonly involved with medication errors/preventable adverse drug events in both settings.
CONCLUSIONS
Medication errors occur frequently in critically ill children admitted to paediatric and neonatal intensive care units and may lead to patient harm. Important targets such as dosing errors and anti-infective medications were identified to guide the development of remedial interventions.
Topics: Adolescent; Child; Child, Preschool; Drug-Related Side Effects and Adverse Reactions; Humans; Infant; Infant, Newborn; Intensive Care Units, Neonatal; Intensive Care Units, Pediatric; Medication Errors; Prevalence
PubMed: 31410745
DOI: 10.1007/s40264-019-00856-9 -
Journal of General Internal Medicine Oct 2019Computerized physician order entry and clinical decision support systems are electronic prescribing strategies that are increasingly used to improve patient safety.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Computerized physician order entry and clinical decision support systems are electronic prescribing strategies that are increasingly used to improve patient safety. Previous reviews show limited effect on patient outcomes. Our objective was to assess the impact of electronic prescribing strategies on medication errors and patient harm in hospitalized patients.
METHODS
MEDLINE, EMBASE, CENTRAL, and CINAHL were searched from January 2007 to January 2018. We included prospective studies that compared hospital-based electronic prescribing strategies with control, and reported on medication error or patient harm. Data were abstracted by two reviewers and pooled using random effects model. Study quality was assessed using the Effective Practice and Organisation of Care and evidence quality was assessed using Grading of Recommendations Assessment, Development, and Evaluation.
RESULTS
Thirty-eight studies were included; comprised of 11 randomized control trials and 27 non-randomized interventional studies. Electronic prescribing strategies reduced medication errors (RR 0.24 (95% CI 0.13, 0.46), I 98%, n = 11) and dosing errors (RR 0.17 (95% CI 0.08, 0.38), I 96%, n = 9), with both risk ratios significantly affected by advancing year of publication. There was a significant effect of electronic prescribing strategies on adverse drug events (ADEs) (RR 0.52 (95% CI 0.40, 0.68), I 0%, n = 2), but not on preventable ADEs (RR 0.55 (95% CI 0.30, 1.01), I 78%, n = 3), hypoglycemia (RR 1.03 (95% CI 0.62-1.70), I 28%, n = 7), length of stay (MD - 0.18 (95% - 1.42, 1.05), I 94%, n = 7), or mortality (RR 0.97 (95% CI 0.79, 1.19), I 74%, n = 9). The quality of evidence was rated very low.
DISCUSSION
Electronic prescribing strategies decrease medication errors and adverse drug events, but had no effect on other patient outcomes. Conservative interpretations of these findings are supported by significant heterogeneity and the preponderance of low-quality studies.
Topics: Decision Support Systems, Clinical; Drug-Related Side Effects and Adverse Reactions; Electronic Prescribing; Humans; Medication Errors; Outcome Assessment, Health Care; Randomized Controlled Trials as Topic
PubMed: 31396810
DOI: 10.1007/s11606-019-05236-8 -
Nursing Forum Nov 2022This paper addresses the ethics of the prosecution of nurse RaDonda Vaught for a medication error that led to the death of her patient. It is argued that the prosecution...
This paper addresses the ethics of the prosecution of nurse RaDonda Vaught for a medication error that led to the death of her patient. It is argued that the prosecution of Ms. Vaught was wrong; however, in contrast to some commentators, it is argued that the wrongness of Ms. Vaught's prosecution did not stem from its effects on patient safety, but from the fact that the charges, in this case, were legally and ethically unjustified in themselves.
Topics: Female; Humans; Medication Errors
PubMed: 36352526
DOI: 10.1111/nuf.12838